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Suggest Treatment For Severe Depression Despite Medications

Posted on Mon, 12 Dec 2016

Question: Hi. I have bipolar schizoaffective disorder and I'm on a lot of medication. However, my depression has gotten to the point that my everyday life is unmanageable. My doctor's response was that I need to learn to cope with it. But, I don't see how anyone is expected to live like this. I've thought about hospitalization, but I'm really trying to stay away from that. Any suggestions?

Answered by Dr. Alexander H. Sheppe (12 minutes later)

Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

What are the medications you currently take? This will help me make a productive suggestion for you. I will say that if you are suicidal, you need to call 911 and seek immediate hospitalization for depression.

Dr. Sheppe

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Alexander H. Sheppe (1 hour later)

Divalproex (Depakote) ER
500 mg in the morning & 1000 evening

Gabapentin (Neurontin)
300 mg 3x day

Pristiq
50 mg at bedtime

Trazadone
100 mg at bedtime

Clonazepam
0.5 mg up to twice a day

Hydroxyzine Pamoate (Vistaril)
25 mg every 8 hrs as needed

Metoprolol
25 mg morning and evening

Metformin -
500 mg at morning & bedtime

Answered by Dr. Alexander H. Sheppe (19 hours later)

Brief Answer:
Followup

Detailed Answer:
To address depression, I would take two approaches. First, I would increase the Pristiq to 100mg daily. Additionally, I would pursue intensive once or twice weekly psychodynamic or cognitive behavioral psychotherapy. This combination is likely to be effective in improving your mood.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Alexander H. Sheppe (1 hour later)

I've done several months of ECT, and while it works for the depression, it takes away my memory, badly. Any suggestions?

Answered by Dr. Alexander H. Sheppe (15 hours later)

Brief Answer:
Followup

Detailed Answer:
ECT is very good for depression. It can sometimes cause memory problems. I would recommend talking to your ECT doctor about switching to ultrabrief pulse right unilateral ECT, which has fewer memory side effects.

I recommend treatment with an SSRI medication like escitalopram, and/or cognitive behavioral psychotherapy. I would expect these somatic symptoms of anxiety to resolve with treatment.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Alexander H. Sheppe (10 hours later)

So basically the jist that I'm getting from reading up on this kind of depression is that there are three ways to treat it, meds, talk therapy, and at last resort, ECT. Am I correct in thinking that? Is there something I'm missing?

And when is hospitalization recommended again?

Answered by Dr. Alexander H. Sheppe (5 hours later)

Brief Answer:
Followup

Detailed Answer:
You are correct. Those are the treatment options.

Hospitalization is recommended for acute suicidality, and sometimes to begin ECT.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. REMY KOSHY